Hydatid cyst

Hydatid cyst: Description, Causes and Risk Factors:A cyst formed in the liver, or, less frequently, elsewhere, by the larval stage of Echinococcus, chiefly in ruminants; two morphologic forms caused by Echinococcus granulosus are found in humans: the unilocular hydatid cyst and the osseous hydatid cyst; a third form in humans is the alveolar hydatid cyst, caused by Echinococcus multilocularis.
Hydatid cyst is a parasitic infestation by a tapeworm of the genus Echinococcus. It is not endemic in the United States, but the change of immigration patterns and the improvement of transcontinental transportation over the past 4 decades have caused a rise in the profile of this previously unusual disease throughout North America. This has led to the necessity for physicians to be more aware of its clinical features, diagnosis, and management.
The incubation period for all species of Echinococcus can be months to years or even decades. It largely depends on the location of the cyst in the body and how fast the cyst is growing.
Hydatid cyst often caused by the tapeworm of the genus Echinococcus. Of the 4 known species of Echinococcus, 3 are of medical importance in humans. These are Echinococcus granulosus, causing cystic echinococcosis (CE); Echinococcus multilocularis, causing alveolar echinococcosis (AE); and Echinococcus vogeli. E granulosus is the most common of the three. E multilocularis is rare but is the most virulent, and E vogeli is the most rare.
All disease-causing species of Echinococcus are transmitted to intermediate hosts via the ingestion of eggs and are transmitted to definitive hosts by means of eating infected, cyst-containing organs. Humans are accidental intermediate hosts that become infected by handling soil, dirt or animal hair that contains eggs.
Commonly encountered in endemic areas with incidence of 1-22/100,000 inhabitants. The incidence of alveolar Echinococcus is 0.03-1.2/100,000 inhabitants.
There are currently no effective drugs or vaccines to protect humans against the disease.
Symptoms:
The symptoms of hydatid disease depend on which organs are affected. The most commonly affected organ is the liver. The kidneys, brain and lungs are sometimes affected. In rare cases, hydatid cysts may form in the thyroid gland or heart or within bone. Symptoms can occur a long time after infection, sometimes months or years later. Sometimes there are no symptoms at all. If they occur, symptoms may include:
Stomach upset.

Diagnosis:
The results of routine laboratory blood work are nonspecific. Liver involvement may be reflected in an elevated bilirubin or alkaline phosphatase level. Leukocytosis may suggest infection of the cyst. Eosinophilia is present in 25% of all persons who are infected, while hypogammaglobinemia is present in 30%.
Almost every serodiagnostic technique has been evaluated for echinococcosis, with variable results.
The indirect hemagglutination test and the enzyme-linked immunosorbent assay (ELISA) have a sensitivity of 80% overall (90% in hepatic echinococcosis, 40% in pulmonary echinococcosis) and are the initial screening tests of choice.Immunodiffusion and immunoelectrophoresis demonstrate antibodies to antigen 5 and provide specific confirmation of reactivity.The ELISA test is useful in follow-up to detect recurrence.
Investigations:
Blood CP.

Serology.

Casoni's Reaction.

X-Ray Abdomen.

Ultrasonography (USG) and Computed tomography Scanning (CT scan).

ERCP (endoscopic retrograde cholangiopancreatography).

Treatment:
Three treatment options for uncomplicated hydatid cyst of the liver.

Surgery be it radical or conservative.

Chemotherapy with benzimidazole.

Percutaneous drainage.

Combinations of two or more is a fourth treatment option.

Percutaneous treatment: This method has been used to treat liver hydatid cyst with Gharbi type I to III. Several percutaneous techniques have been used including : percutaneous puncture and curettage, double percutaneous aspiration and injection, and percutaneous evacuation of cyst.
Surgical treatment for open approach.
Kocher incision is made in right sub costal margin.

Inspect abdominal viscera for potential sites of dissemination.

Pack the area around cyst with swaps soaked with hypertonic sodium chloride solution as a scolicidal agent.

Through a three way stop cock the cyst is punctured and the content aspirated into a 50 ml syringe.

Replace aspirated fluid with a scolicidal agent.

Protruding dome is incised and hydatid fragments with laminated membrane are removed with a sponge holding forceps.

Residual cavity of the cyst was scrubbed with swabs soaked with povidone-iodine and carefully inspected for biliary communication.

Suture any visible fistula with non absorbable sutures. Place two drains one in the cavity and the other drain place sub hepatically to monitor for biliary leakages.

Do cavogram (an angiogram of a vena cava) on day 6 to 7 to rule out biliary fistula before removal of drains.

Radical surgical approach involves pericystectomy, partial hepatectomy, or lobectomy.
Conservative surgical approach include simple tube drainage, partial cystectomy with or with out omentoplasty, and marsupialization (exteriorization of a cyst or other such enclosed cavity by resecting the anterior wall and suturing the cut edges of the remaining wall to adjacent edges of the skin, thereby creating a pouch).
Chemotherapy: Benzimidazoles (albendazole and mebendazole) have been used for treatment of patient with hydatid cysts of the liver and lungs. They are used in patients who are unfit for surgery or extensively disseminated cystic disease. They have also been used as adjunct in the surgical procedures.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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